Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis

Raphael Beck, Nael Elias, Shay Shoval, Naveh Tov, Gil Talmon, Simon Godfrey, Lea Bentur, Raphael Beck, Nael Elias, Shay Shoval, Naveh Tov, Gil Talmon, Simon Godfrey, Lea Bentur

Abstract

Aim: We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis.

Methods: Computerized lung sounds analysis with quantification of wheezing and crackles and a clinical score were used during a double blind, randomized, controlled nebulized treatment pilot study. Infants were randomized to receive a single dose of 1 mgr nebulized l-epinephrine or 2.5 mgr nebulized albuterol. Computerized quantification of wheezing and crackles (PulmoTrack) and a clinical score were performed prior to, 10 minutes post and 30 minutes post treatment. Results were analyzed with Student's t-test for independent samples, Mann-Whitney U test and Wilcoxon test.

Results: 15 children received albuterol, 12 received epinephrine. The groups were identical at baseline. Satisfactory lung sounds recording and analysis was achieved in all subjects. There was no significant change in objective quantification of wheezes and crackles or in the total clinical scores either within the groups or between the groups. There was also no difference in oxygen saturation and respiratory distress.

Conclusion: Computerized lung sound analysis is feasible in young infants with RSV bronchiolitis and provides a non-invasive, quantitative measure of wheezing and crackles in these infants.

Trial registration: ClinicalTrials.gov NCT00361452.

Figures

Figure 1
Figure 1
Sonogram of subject treated with albuterol, showing no response.
Figure 2
Figure 2
Sonogram of subject treated with epinephrine showing significant reduction in wheezing.
Figure 3
Figure 3
Sonogram of subject treated with epinephrine showing transient response with relapse.

References

    1. Committee on Infectious Diseases, American Academy of Pediatrics . Respiratory syncytial virus. In: Pickering LK, editor. Red Book: Report of the Committee on Infectious Disease. 26. Elk Grove Village, IL: American Academy of Pediatrics; 2003. p. 523.
    1. Collins PL, McIntosh K, Chanock RM. Respiratory syncytial virus. In: Fields BN, Knipe DM, Howley PM, editor. Fields Virology. 3. Philadelphia: Lippincott-Raven; 1995. pp. 1313–51.
    1. McIntosh K. Respiratory syncytial virus. In: Evans A, Kaslow R, editor. Viral Infection in Humans: Epidemiology and Control. 4. New York: Plenum; 1997. pp. 671–705.
    1. Rodriguez WJ. Management strategies for respiratory syncytial virus infection in infants. J Pediatr. 1999;135:545–550.
    1. Goodman D. Bronchiolitis. In: Behrman RE, Kliegman RM, Jenson HB, editor. Nelson Textbook of Pediatrics. 17. Philadelphia : W.B. Saunders Company; 2004. pp. 1415–1417.
    1. Alario AJ, Lewander WJ, Dennehy P, Seifer R, Mansell AL. The efficacy of nebulized metaproterenol in wheezing infants and young children. Am J Dis Child. 1992;146:412–8.
    1. Klassen TP, Row PC, Sutcliffe T, Ropp LJ, McDowell IW, Li MM. Randomized trial of salbutamol in acute bronchiolitis. J Pediatr. 1991;118:807–11. doi: 10.1016/S0022-3476(05)80051-4.
    1. Schuh S, Canny G, Reisman JJ, Kerem E, Bentur L, Petric M, Levinson H. Nebulized albuterol in acute bronchiolitis. J Pediatr. 1991;118:807–811. doi: 10.1016/S0022-3476(05)80051-4.
    1. Goh A, Chay OM, Foo AL, Ong EK. Efficacy of bronchodilators in the treatment of bronchiolitis. Singapore Med J. 1997;38:326–8.
    1. Gadomski AM, Lichenstein R, Horton L, King J, Keane V, Permutt T. Efficacy of albuterol in the management of bronchiolitis. Pediatrics. 1994;93:907–912.
    1. Wang EE, Milner R, Allen U, Maj H. Bronchodilators for treatment of mild bronchiolitis: a factorial randomized tria. Arch Dis Child. 1992;67:289–293.
    1. Sanchez I, Koster JD, Powell RE, Wolstein R, Chernick V. Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infants with bronchiolitis. J Pediatr. 1993;122:145–51. doi: 10.1016/S0022-3476(05)83508-5.
    1. Lowell DI, Lister G, Von Koss H, McCarthy P. Wheezing in infants: The response to epinephrine. Pediatrics. 1987;79:939–945.
    1. Kristjansson S, Lodrup Carlsen KC, Wennergren G, Strannegard IL, Carlsen KH. Nebulized racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers. Arch Dis Child. 1993;69:650–654.
    1. Rejjonen T, Korppi M, Pikakangas S, Tenhola S, Remes K. The clinical efficacy of nebulized racemic epinephrine and albuterol in acute bronchiolitis. Arch Pediatr Adolesc Med. 1995;149:686–692.
    1. Menon K, Sutcliffe T, Klassen TP. Clinical and laboratory observations, A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr. 1995;126:1004–7. doi: 10.1016/S0022-3476(95)70234-2.
    1. Numa AH, Williams GD, Dakin CJ. The effect of nebulized epinephrine on respiratory mechanics and gas exchange in bronchiolitis. Am J Respir Crit Care Med. 2001;164:86–91.
    1. Bertrand P, Araibar H, Castro E, sanchez I. Efficacy of nebulized epinephrine versus salbutamol in hospitalized infants with bronchiolitis. Pediatr Pulmonol. 2001;31:284–288. doi: 10.1002/ppul.1040.
    1. Wainwright C, Altamirano L, Cheney M, Cheney J, Barber S, Price D, Sue Moloney, Kimberley A, Woolfield N, Cadzow S, Fiumara F, Wilson P, Mego S, VandeVelde D, Sanders S, O'Rourke P, Francis P. A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. N Eng J Med. 2003;349:27–35. doi: 10.1056/NEJMoa022226.
    1. Mallol J, Sly P. Effect of chloral hydrate on arterial oxygen saturation in wheezy infants. Pediatr Pulmonol. 1988;5:96–99. doi: 10.1002/ppul.1950050206.
    1. Baughman RP, Loudon RG. Quantification of wheezing in acute asthma. Chest. 1984;86:718–722.
    1. Pasterkamp H, Tal A, Leahy F, Fenton R, Chernick V. The effect of anticholinergic treatment on postexertional wheezing in asthma studied by phonopneumography and spirometry. Am Rev Respir Dis. 1985;132:16–21.
    1. Tal A, Sanchez I, Pasterkamp H. Respirosonography in infants with acute bronchiolitis. Am J Dis Child. 1991;145:1405–1410.
    1. Bentur L, Beck R, Shinawi M, Naveh T, Gavriely N. Wheeze monitoring in children for assessment of nocturnal asthma and response to therapy. Eur Respir J. 2003;21:621–626.
    1. Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis. 1992;145:106–9.
    1. Murphy RL, Del Bono E, Davidson F. validation of an automatic crackle (rale) counter. Am Rev Respir Dis. 1989;140:1017–1020.
    1. Kiyokawa H, Greenberg M, Shirota K, Pasterkamp H. Auditory Detection of Simulated Crackles in Breath Sounds. Chest. 2001;119:1886–1892. doi: 10.1378/chest.119.6.1886.
    1. Wohl ME, Chernick V. State of the Art: bronchiolitis. Am Rev Respir Dis. 1978;118:759–781.
    1. Kellner J, Chisson A, Gadomski A, Wang E. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2000;2:CD001266.
    1. Baughman RP, Loudon RG. Lung sound analysis for continuous evaluation of airflow obstruction in asthma. Chest. 1985;88:364–368.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa